Phobias are a category of anxiety disorder characterized by experiencing irrational fear when exposed to certain stimuli or circumstances. A person with agoraphobia experiences an irrational fear of any situation or place that might cause them to feel embarrassed, helpless, or trapped. Most individuals believe agoraphobia is a fear of going outside. Although this is one way the phobia can manifest, it’s just one of many ways this underlying fear of being trapped can show up. The fear tends to be projected into anticipated or actual situations like using public transit, being in enclosed spaces, being in open spaces, being in crowds, or standing in line. Some researchers believe the root of agoraphobia is a fear of losing control.
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Out Of Proportion Anxiety Or Fear
One of the biggest warning signs of agoraphobia is experiencing out of proportion anxiety or fear. The fear patients experience is not rational or conducive to the actual situation. A difficult aspect of agoraphobia is that oftentimes the fear is of fear itself. When a person is aware they’re prone to panic in certain situations, they may be terrified of becoming trapped or being unable to get help when the panic intensifies. That feeling of helplessness leads to more fear, resulting in a vicious cycle. Someone with agoraphobia may become so afraid of being trapped or helpless that they begin avoiding public places and other situations. Going out in public can lead to feelings of intense panic, which can turn into a self-fulfilling prophecy. An individual with agoraphobia might struggle to feel safe when they’re alone in an unfamiliar situation. They may feel like they need to be accompanied by another person to help mitigate their fear of being trapped or isolated.
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Avoiding Triggering Situations
Patients with agoraphobia will often avoid triggering situations, even when this has a definite impact on their day-to-day life and ability to function. They might avoid social situations they’d otherwise enjoy, or they might avoid public transportation so staunchly that it invokes great time or monetary costs. In severe cases, individuals with agoraphobia might experience fear so severe that it interferes with their ability to keep a job or leave the house at all. It can be difficult to treat agoraphobia because treatment requires a person to face triggering situations. However, effective treatment allows a patient to face their fears in a controlled environment, which in turn allows them to create positive associations with the normally triggering circumstances. A sign of agoraphobia is individuals having specific situations or circumstances they avoid because of the fears of being trapped or helpless when they panic. If individuals brave the triggering situation, they may be extremely distressed during the experience in a way that is disproportionate to normal levels of fear.
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Avoidance Lasts More Than Six Months
To receive an official diagnosis of agoraphobia, an individual must experience these fears and avoidance for longer than six months. This is a new diagnostic criterion included in the DSM-5. In the DSM-4, which was the previous set of diagnostic criteria, only patients under eighteen years old needed to experience the avoidance for six months. This stipulation is included so the condition isn’t overdiagnosed based on fleeting, unrelated, or transient fears. With that said, patients don’t have to suffer for six months before seeking treatment. Even if the underlying cause isn’t diagnosed as agoraphobia, fears severe enough to cause this avoidance should be treated. The longer the fear goes without treatment, the more ingrained the avoidant behaviors tend to become. Even if patients don’t avoid every potentially triggering situation, they might still experience extreme and disproportionate stress that makes them want to avoid the situation. This can count toward a diagnosis. In the end, the exact label for the phobia doesn’t matter. If individuals are experiencing fear so severe that it affects their day-to-day functioning, and they’re avoiding situations for more than six months, there’s some kind of anxiety disorder that needs treatment.
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Leaving The House
In media, agoraphobia is most commonly depicted as an inability to leave the house. This has caused some individuals to incorrectly believe agoraphobia is a simple fear of being outside. The truth is more complicated. When a person with agoraphobia is afraid to leave home, it tends to be because of the uncontrolled elements outside the house. They are terrified they’ll become trapped or isolated if they panic outside the home. The fear of being helpless is stronger than the desire to leave the house. They may feel like they can’t leave the house without a companion because of the chances of something bad happening. The root of this type of agoraphobia can sometimes be trauma. If an individual experienced a traumatic experience they couldn’t control outside of the home, they may develop a fear that going outside will cause the experience to repeat itself.
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Crowds can pose a serious problem for individuals with agoraphobia. They may avoid any place that might be crowded including public transit, heavy traffic, crowded restaurants, busy city streets, outdoor venues, or any other place with uncontrolled and large amounts of people. They will have a strong fear that being in a crowd will cause them to be trapped, isolated, and unable to escape if they experience panic. They may be afraid of strangers seeing them experiencing panic symptoms, or they may be afraid that the proximity of strangers will make it impossible for them to escape. There are several reasons this type of fear might develop. Some individuals experience this kind of fear due to an underlying panic disorder, sensory issues around others, or negative experiences that occurred in crowds. Not every patient with agoraphobia avoids crowds, but this is one of the most common ways the phobia manifests.